On February 8, 2007, Ann Nicole Smith apparently overdosed and died 5 minutes away from my office at the Seminole Indian Hard Rock Hotel, a gambling casino on the Indian Reservation.

Drug Overdose

Ann Nicole Smith’s death was officially attributed to drug overdose. However, the autopsy report described a low thyroid condition called Hashimoto’s thyroid disease, a common condition causing low thyroid function.(1) Ann Nicole Smith was also said to be taking human growth hormone (HGH).(7) Of course, this information wasn’t mentioned in the autopsy report. The obvious question is, “Why was Ann Nicole taking Growth Hormone when she really needed thyroid medication ?”

Left Image: Ann Nicole Smith at the 2005 MTV Music Awards Courtesy of Wikipedia (47)(48)

Although mainstream medicine is staunchly opposed to HGH use by Aging Baby Boomers, the practice has caught the attention of some seniors groups, and seems to be growing in spite of opposition by the Institute of Medicine and JAMA .(2)(3)(4)(5)(6) As we find in the case of Ann Nicole Smith, I propose the idea that the real medical problem is usually thyroid deficiency rather than Growth Hormone Deficiency.

Human Growth Hormone at Cenegenics

A few years ago in 2005, I spent a week doing a clinical fellowship at the Cenegenics Clinic in Las Vegas with Alan Mintz MD.(8) You may have seen Alan Mintz when he appeared on CBS Television 60 Minutes to describe his clinic program and talk about the Age Management Medicine Protocols offered there.(9) Sadly, Dr. Alan Mintz passed away June 3, 2007, a little less than a year after his interview on the 60 minutes CBS television show.(10)

Dr. Mintz was a radiologist, and a visionary and a pioneer in his field. He inspired many doctors, myself included, to embark on a new career in natural medicine and bio-identical hormones, and his presence will be greatly missed.

In this same CBS 60 minutes television interview, Alan Mintz disclosed that many of their patients were given treatments with human growth hormone (HGH) based on a protocol for Adult Growth Hormone Deficiency.(11) (12) I highly recommend the Cenegenics clinics as a world class medical clinic, with excellent doctors and support staff.

Thyroid Hormone, The Missing Piece of the Puzzle

Various vitamin and hormone treatments such as HGH (human growth hormone), testosterone, DHEA, estrogen and progesterone are considered by aging baby boomers to have anti-aging properties. However I would suggest that one need look no further than thyroid hormone, which is perhaps the best and most efffective anti-aging medication. Thyroid Hormone changes the body composition, skin and hair quality, and produces a more youthful appearance. In my experience, these youthful changes are much more profound with thyroid hormone than any other treatment in patients with low thyroid.

Yet, many the large clinics involved in Age Management or so-called anti-aging medicine tend to be conservative when it comes to offering thyroid treatment. They usually hesitate to give thyroid medication if the labs are normal, or if they do give thyroid hormone, it is usually Synthroid rather than natural dessicated thyroid hormone like Nature-Throid from RLC Labs.(13)(32)

Left Image: Synthroid Courtesy of Wikipedia

Synthroid is a thyroid pill which contains only T4 (thyroxine), while the natural thyroid (Nature-Throid) contains both T3 and T4, accounting for the better clinical results of the natural thyroid.(32) Mainstream medical practice relies on the TSH test to determine when to treat with thyroid hormone (lab range 0.5 – 5.5) , so most people with low thyroid are missed by the medical system, and are not given thyroid hormone medication. Endocrinologists at Walter Reed have found that patients prefer the Natural Thyroid over Synthroid.

Mark Starr and Type Two Hypothyroidism

A few months after meeting with Alan Mintz, M.D. at the Cenegenics clinic, I attended a medical meeting of the ICIM (Integrative and Complementary Medicine) in Grand Rapids Michigan. At this meeting, I spoke with Mark Starr, M.D. who presented his approach to diagnosis and treatment of the low thyroid condition, which he calls Type Two Hypothyroidism.(14)

Mark Starr’s lecture and his book on the same topic were a real eye opener for me because he claimed that while 30% of the population are low thyroid, they are ignored and go untreated by mainstream medicine. These unfortunate souls drag themselves from doctor to doctor with labels such as chronic fibromyalgia, and chronic fatigue, and suffer from hair loss, constipation, depression and a host of other symptoms described by Dr. Jacob Teitelbaum.(15) Dr. Starr explained why thyroid blood tests such as the TSH are unreliable. Dr. Starr instead relies on old fashioned clinical judgment to decide when to treat with thyroid hormone and how much thyroid medication to give. (16)(17)(18)

One of the tried and true clinical parameters of thyroid function is the delayed Achilles reflex time which the old time docs used routinely for practical management of low thyroid before the blood tests were devised. Checking the Achilles reflex is still accepted and used by mainstream medicine today as an indicator of thyroid function.(19)(20)(21)(22)(23)(24).

I was therefore really excited to meet Drs. Konrad Kail and Daryl Turner at their booth at the American Academy of Anti-Aging Medicine Meeting in 2005.(25)(26)(27)(28) Drs. Kail and Turner developed the Thyroflex instrument, a reflex hammer connected to a laptop computer which measures reflex time in milliseconds.(27)

Left Image: Achilles Tendon Courtesy of Wikipedia

They do not routinely use the Achilles Tendon reflex though. Instead, they decided to use the Brachio-Radialis muscle of the forearm, a more convenient way to illicit the reflex while the patient is seated in a comfortable chair. A delayed reflex time is the finding which indicates low thyroid.

They found excellent correlation between reflex time and thyroid function as measured by basal metabolic rate in patients before and after treatment with natural thyroid. Their study found a predictive Value of a Positive Test = 0.95 and a Predictive Value of a Negative Test= 0.017, which I thought was quite good.(29)(30)

Our Thyroflex Experience

We are proud to be the first medical clinic in Florida to offer this noninvasive Thyroflex test which really represents the best modern medicine has to offer, while at the same time validating the original knowledge of early thyroid clinical practice. After using the Thyroflex machine for about one year, we have found it to be especially useful in those cases in which the TSH is paradoxically low even though the patient is low thyroid. Note: a low TSH indicates high thyroid function, while a high TSH indicates low thyroid function. Many people are confused by this.

This paradoxically low TSH is called hypothalamic dysfunction, and Jacob Teitelbaum MD sees this frequently in his chronic fatigue patients.(31) Since in these cases the TSH is usually below 3, no mainstream doctor would be willing to give thyroid hormone treatment to these unfortunate souls. With the confidence of a delayed reflex time on a Thyroflex test, we can feel comfortable giving these people the badly needed thyroid, and the results have been astounding.

Our approach to diagnosis of low thyroid uses a lengthy questionnaire which goes over 70 symptoms of low thyroid (listed below), a complete thyroid blood panel including TSH, free T3 and free T4, and a physical examination which includes measurement of reflex time with the Thyroflex. Also included is a basal body temperature chart filled out by the patient at home.

A Trial of Low Dose Thyroid is Very Safe

Once it has been determined that thyroid hormone is likely to be beneficial, a trial of low dose Nature-Throid from RLC labs (Western Research) is given with a small half grain tablet every other day, while a log book is kept by the patient describing any changes in energy or other symptoms. Any symptoms of thyroid excess such as palpitations, feeling of warmth, anxiety or insomnia are noted in the log book. After 8 days, the log book is reviewed to determine if the thyroid was of benefit. In addition, Iodine supplementation with Iodoral is routinely given as described in a previous article on Iodine and Breast Cancer Prevention.(45)

We have found that monitoring symptoms by recording any changes in a log book, as well as small half grain gradual increments in thyroid dosage makes this program very safe. In the event the patient experiences palpitations, they are instructed to hold any further thyroid medication and inform the physician.

Once it has been determined that thyroid hormone is likely to be beneficial, a trial of low dose Nature-Throid from RLC labs (Western Research) is given with a small half grain tablet every other day, while a log book is kept by the patient describing any changes in energy or other symptoms. Any symptoms of thyroid excess such as palpitations, feeling of warmth, anxiety or insomnia are noted in the log book. After 8 days, the log book is reviewed to determine if the thyroid was of benefit. In addition, Iodine supplementation with Iodoral is routinely given as described in a previous article on Iodine and Breast Cancer Prevention.() We have found that monitoring symptoms by recording any changes in a log book, as well as small half grain gradual increments in thyroid dosage makes this program very safe. In the event the patient experiences palpitations, they are instructed to hold any further thyroid medication and inform the physician. For more information, visit my web site Jeffrey Dach MD4700 Sheridan Suite THollywood, Florida 33021954-983-1443(1) Anna Nicole Smith Autopsy Released, Coroner: Ex-Playmate died from accidental sedative overdose.() Aging Baby Boomers turn to hormone, Some doctors concerned about growing ‘off-label’ use of drug Sabin Russell, Chronicle Staff Writer, Monday, November 17, 2003 San Francisco Chronicle () HGH (Human Growth Hormone) HGH and effects on aging – An exciting discovery made about 15 years ago has linked the aging process to declining levels of certain hormones. SeniorMag.com() Provision or Distribution of Growth Hormone for “Antiaging”, COMMENTARY Clinical and Legal Issues. Thomas T. Perls, MD, MPH; Neal R. Reisman, MD, JD; S. Jay Olshansky, PhD. JAMA. Oct 26 2005;294:2086-2090. Full Text PDF.

(10) http://www.reviewjournal.com/obituaries/individual_display.jsp?obitID=2211636
ALAN MINTZ M.D. Alan P. Mintz, M.D., cofounder and CEO of Cenegenics Medical Institute, passed away June 3, 2007, as a result of a brain hemorrhage. He was 69 years old. Born in Chicago, Alan was a graduate of the University of Chicago and earned a doctor of medicine degree from the University of Illinois – School of Medicine. He served as a physician in the U.S. Navy, prior to postgraduate training in radiology.

(14) http://www.type2hypothyroidism.com/
Type Two Hypothyroidism Book by Mark Starr. This is an astonishing book revealing the cause and successful treatment for the plague of illnesses affecting western civilization; including obesity, heart attacks, depression, diabetes, strokes, headaches, chronic fatigue, and many more. In Dr. Starr’s description Type 2 Hypothyroidism, he presents overwhelming evidence showing a majority of Americans suffer this illness, which is due to environmental and hereditary factors. Laboratory testing used to diagnose hypothyroidism is completely inadequate, and current treatment for hypothyroidism is ineffective.

(20) http://www.ncbi.nlm.nih.gov/pubmed/6895943Probl Endokrinol (Mosk). 1982 Jan-Feb;28(1):34-8. [Reflexometry as a supplementary study method in thyroid hypofunction][Article in Russian] Gaidina GA, Matveeva LS, Lazareva SP.
A correlation was established between the time of the Achilles reflex and the biochemical characteristics of thyroid function (total thyroxin and triiodothyronine levels, thyroxin-binding capacity of the blood serum proteins, the basal TTH level) in patients with grave and moderately expressed hypothyroidism.

(22) http://www.ncbi.nlm.nih.gov/pubmed/952638Aust Fam Physician. 1976 May;5(4):550-9, 561. A screening test for thyroid function.Goodman E. The Achilles tendon reflex half relaxation time measurement (ART) has been used by many physicians both as a diagnostic test and for the assessment of progress in thyroid gland malfunction.

(24) http://www.ncbi.nlm.nih.gov/pubmed/3658939 Probl Endokrinol (Mosk). 1987 May-Jun;33(3):6-9. [Changes in the duration of the Achilles reflex in euthyroid goiter in children][Article in Russian]Gaidina GA, Alekseeva RM, Bobrovskaia TA, Lazareva SP. Changes in the duration of the Achilles reflex were studied in subclinical disturbances of thyroid function. A significant conformity of the levels of TSH, T3, T4 to the duration of the Achilles reflex was shown.

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